Risk Factors for Early Intestinal Resection in Pediatric Crohn's Disease: A Nationwide Cohort Study

Complicated disease affects a substantial proportion of pediatric Crohn's disease (CD) patients and leads to surgery. A subset of children requires intestinal resection shortly after diagnosis. Several risk factors for surgery are known; however, the predictors of these early resections have not been well defined. We aimed to characterize this patient group and identify risk factors associated with early intestinal resections.

We performed a retrospective analysis of patients under 18 y diagnosed with CD between 2010 and 2019, based on the Hungarian Pediatric inflammatory bowel disease Registry. We compared those patients who underwent intestinal resection within 6 mo after diagnosis (very early surgery group, VES) with those who did not require resection within 6 mo. Descriptive statistics and logistic regressions were used for the analysis.

Out of 1040 newly diagnosed pediatric CD patients, 27 (2.6%) underwent intestinal resection within 6 mo of diagnosis. The mean age of the two groups did not significantly differ. The proportion of females was significantly higher in the VES group (63.0% versus 42.3%, P = 0.03). Multivariate analysis identified abdominal pain without diarrhea (odds ratio [OR]: 5.59; P = 0.02) and higher pediatric CD activity index (OR: 1.05; P = 0.02) as risk factors for VES. Diagnostic delay (OR: 0.99; P = 0.74) and perianal involvement (OR 2.84; P = 0.12) were not predictive for VES.

VES is rare in pediatric CD, with a possible female predominance. Higher pediatric CD activity index at diagnosis indicates greater risk for early surgery.